AB1544 PARAVERTEBRAL MUSCLES TRIGGER POINTS ATTACHED TO FACET JOINTS ARTHROSIS ARE PREFERRED TARGETS FOR ULTRASOUND-GUIDED INTERVENTION TO TREAT LOW BACK PAIN
Authors: R. Bubnov, L. Kalika, Z. Pilecki, G. Pilecki
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Facet joints (FJ) arthrosis can be a cause of pain and spinal instability and considered to be a potential target for injection treatment. However, FJ arthropathy is difficult for diagnosis and confirmation associations with pain syndrome, effectiveness of FJ injections is debated. Trigger points (TrPs) are major cause of pain syndromes, dry needling under ultrasound (US) guidance (DN-US) is a crucial therapeutic for treatment of myofascial pain [1], is a proven and effective method for treatment various pain conditions; can restore muscle function and motion [2], reduce fascia overload [3], and can improve movement in spine and also in FJ. <h3>Objectives</h3> <b>Aim</b> was to evaluate the relevance of US for diagnosis of FJ arthrosis as a cause of pain and evaluate the efficacy of DN-US to treat FJ-associated low back pain and improve movement in spine and facet joints. <h3>Methods</h3> We included 26 consecutive patients (15 females, 23-57 years old) with symptoms of LBP, suspected due to uni- and bilateral FJ arthrosis assessed at MRI and CT with three-dimensional reconstructions. Conditions of rheumatic, paresis, advanced injury background were excluded. All patients received DN-US protocol by R. Bubnov [1]: MTrP were identified according to clinical examination, referred pain pattern, US identification; single fine (28G) steel needle DN under US guidance was applied to elicit local twitch response (LTR) and/or `needle grasp`. Specific recommendations were given to preserve effect after DN-US. <h3>Results</h3> We diagnosed bi- and unilateral FJ arthrosis on US at the levels of Th11-S1 in all patients, assessed fluid in joints, deformation, movement restriction and revealed closely localized TrPs in paravertebral (multifidus) muscles followed by targeted DN-US. We distinguished different pain patterns (referred pain - groin pain, pelvic pain, irradiation to leg, thigh, etc.) which correlated with facet arthrosis localizations. Pain decreased in all patients VAS from 6-8 at baseline to 1-4 immediately and VAS 3-4 at one week after procedure. We noted decreasing in neuropathic pain, detected higher rates of lumbar spine motility, movements in particular segments and FJ were registered on functional US; improvement postural balance in all patients after DN-US. Additional needling sessions to FJ capsule did not induce significant LTR and effective alleviating pain compared to DN-US. All patients had postural imbalance, had multiple bilateral MTrPs: in multifidus muscles at thoracic, lumbar levels; sacroiliac joint dysfunction, shoulders impingement, other associated postural abnormalities; all MTrPs were inactivated, posture imbalance restored. <h3>Conclusion</h3> US is helpful to detect FJ arthrosis; DN-US has a good treatment outcome for low back pain due to FJ arthrosis. Local interventions targeting FJ in most cases not relevant approach; DN-US is not less complicated technically, however, more effective vs targeting FJ. Complex posture assessment and correction is needed. <h3>References</h3> [1]Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13. [2]Bubnov R, Kalika L, Babenko L. Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949 [3]Bubnov R, Kalika L. THE ROLE OF THORACOLUMBAR FASCIA ULTRASOUND IN LOW BACK PAIN - IMPLICATION FOR GUIDED DRY NEEDLING. Annals of the Rheumatic Diseases 2022;81:1714. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1936 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.